在宅看護論実習の現状と課題～統合分野の観点から～

Abstract

目的：本学の在宅看護論実習の充実を図る為、訪問事例に関する記録から、実習の実態を明らかにし、今後の課題を検討した。方法：2010年度から2012年度の3年間で在宅看護論実習を履修した看護学生174名の訪問事例に関する記録から検討を行った。結果：学生が訪問した事例は、3年間ほぼ同じ傾向で、学生1人あたりの訪問件数は、最多が18件、最小3件、平均は7件であった。また、学生の実施したケアは、症状の観察が約80％、清潔ケアが約30％と多く、3年ともに同じ傾向であった。考察：学生の訪問事例の特徴は、我が国の在宅療養者の年齢や家族構成、疾病等の傾向とほぼ同じで、また、平均7事例の訪問をすることができているので、学生が在宅看護を学べる場が得られていると言える。学生のケアの大半が症状観察で、直接ケアが少ないため、在宅看護の技術習得に向けた検討が必要である。1回のみの訪問では、継続した援助や療養者・家族との関係性を築く学習が深められないので、同じ事例に継続した訪問ができるよう実習施設との調整が重要と考える。また、ニーズが高まっている終末期看護や他機関との連携を学生に意識させる工夫も必要であると考えられる。Purpose of the Study: We will therefore describe home visit cases from Principles of Home Care Nursing Practice and the true of Principles of Home Care Nursing Practice at this university in addition to examining future issues. Method: We examined home visit case reports of 174 nursing students who took the Principles of Home Care Nursing Practice course between 2010 and 2012. Results: The mean number of home visits per student was 7 (max: 18 , min: 3) and a significant difference in case summaries was seen over the three years. The nursing care performed by students did not change considerably during the three years and mainly involved observing symptoms (80%)and maintaining hygiene (30%). Conclusions: The age, Family structure, and disease in case of patients visited by student nurses were similar to those of typical patients receiving home care in Japan, and students could learn about home nursing because they could make seven home visits on an average. The majority of care provided by students involves observing symptoms. Students likely provide little direct care due to their insufficient skills; thus, investigation into acquisition of skills in home nursing is required. In one-time-only home visits, students are unable to provide continued assistance, build relationships with patients and their family, and deepen their knowledge; thus, coordinating with practice institutions where the same patient can be visited continuously is important It is thought that the device which makes a student conscious of a terminal care and cooperation with the other organizations with which needs are growing is also required.